| NPI | 1053089623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 068009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134547) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2021-08-31 |